March 2013

How Will The New HIPAA Rule Affect Your Practice?

By Brian McCurdy, Senior Editor

The Department of Health and Human Services has modified the Health Insurance Portability and Accountability Act (HIPAA) with changes that affect both patient access to records and security protocols at podiatry practices.

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As part of the ruling issued in January, patients will have expanded rights to get electronic copies of their health records. The ruling also mandates that HIPAA covered entities notify the affected individuals, secretary of the Department of Health and Human Services and, in some cases, the media of any security breaches. The American Medical Association notes that the new rules require that physicians must assume the “worst case scenario” if patient information is breached, a stricter standard that mandates the reporting of any breach.

What kind of security system should practices have in place to prevent breaches in patient information? Anthony Poggio, DPM, notes that a self-audit as outlined by the Centers for Medicare and Medicaid Services, as part of Meaningful Use, is required even under the old regulations. He notes third parties can advise a practice on how to do this. He emphasizes that it is incumbent on the practice to put these processes in place whether under the old or newer regulations.

Bruce Werber, DPM, suggests that one relatively inexpensive step practices can take is to encrypt every hard drive in the practice and make it a policy not to take any computer out of the office that is not encrypted. He says the practice should ensure that any financial or patient data stored on the cloud is also encrypted. Paper charts should also be secure.

Dr. Werber speculates that identity theft has increased since the institution of HIPAA and that the government’s approach to protecting our identities and our medical information is “severely flawed.” He suggests training staff not to give any information out to anyone, letting the patient be the one providing protected data to company representatives and making sure the practice has patients’ permission to discuss their information.

Practices should also conduct background checks on employees, notes Dr. Werber, who is in private practice in Scottsdale, Ariz. Doctors should change passwords on the computer systems regularly. He also suggests keeping records of all of the practice’s security precautions, so if there is a breach, one can minimize potential fines or legal action by patients.

The Department of Health and Human Services estimates that the final rule would cost practices $100 million a year. “The revised HIPAA regulations are putting an increased financial burden on small medical practices, which appear to be totally unreasonable for groups of one or two or even three physicians,” notes Dr. Werber.

However, Dr. Poggio feels that the costs for practices to implement the new regulations would not change much as they were already required to have a privacy audit system if they have an EMR and have attested already. He says it would incur costs if no system is in place.

“It will be more time consuming to make sure that the system is in place and then to periodically monitor it to make sure it is functioning accordingly, says Dr. Poggio, a medical consultant to several national health insurance and review organizations. “So continually self auditing the system requires diligence.”

Is Ultrasonic Debridement Of Venous Leg Ulcers More Effective?

By Danielle Chicano, Editorial Associate

A recent abstract validating the use of low frequency, high intensity, contact ultrasound for the debridement of venous leg ulcers will be among the poster abstracts presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society (SAWC Spring/WHS) in May.

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Researchers in this randomized trial assessed 76 patients with venous leg ulcers who received either ultrasonic debridement or sharp debridement with a curette. After the 24-week treatment period, authors note that patients receiving ultrasonic debridement healed significantly faster than patients who underwent surgical sharp debridement. Additionally, the incidence of complete healing was greater in the ultrasound patients, according to the study.

Kazu Suzuki, DPM, CWS, concurs that ultrasound debridement is superior to sharp debridement not only when treating venous leg ulcers but also when treating other open wounds. According to Dr. Suzuki, who utilizes a 25 kHz, low-intensity, contact ultrasound device in his practice, ultrasound debridement gives practitioners the ability to clean out micro-debris and biofilm within the wound.

Both the study authors and Dr. Suzuki note that a limitation to using ultrasound debridement is an increase in preparation and performance time. Researchers note that ultrasonic debridement took twice as long to set up and perform as sharp debridement (20.5 minutes versus 10.9 minutes). In light of the increased time, using conventional treatment might be more beneficial in cases of small, shallow or minor wounds, explains Dr. Suzuki, the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers in Los Angeles.

In addition to an increase in time, Dr. Suzuki notes an added limitation with any debridement procedure is that patients may often require several office visits to completely clean out the non-viable tissues.

“I often use collagenase ointment in between the wound care center visits to aid in debriding these remnants of non-viable tissues,” offers Dr. Suzuki. He notes that adequate blood flow and proper vascular examination can help ensure successful debridement in many cases.

“In our center, we utilize a laser Doppler-based skin perfusion pressure monitor as well as a handheld Doppler to get the baseline perfusion on wound patients on the first visit,” explains Dr. Suzuki.

According to Dr. Suzuki, when debriding a venous leg ulcer, specifically, “you may want to get a vascular specialist to check the patient for venous reflux and varicose veins,” which often connect to the leg ulcer.

While ultrasound therapies have been studied extensively throughout Europe and proven effective in the United States, Dr. Suzuki notes he is in the process of drafting another ultrasound debridement study in Japan.

The SAWC Spring/WHS will be held May 1-5 in Denver. For more info, visit www.sawcspring.com[4] .

Can The Presence Of PAD Predict A Second Amputation?

By Brian McCurdy, Senior Editor

An abstract to be presented at the upcoming SAWC Spring/WHS is a reminder of the importance of assessing peripheral arterial status in patients who have received minor lower extremity amputations.

The abstract focused on 163 patients with diabetes divided into two groups: minor amputation (initial minor amputation followed by at least one minor amputation) and major amputation (initial minor amputation followed by at least one major amputation). In the minor group, authors noted that 22.23 percent had severe peripheral arterial disease (PAD) whereas 71.15 percent in the major amputation group had severe PAD. The abstract authors emphasize that referral to a vascular surgeon may delay or prevent major amputation.

Peter Blume, DPM, concurs that PAD is a common risk factor for major limb amputation.

As he notes, an appropriate way to assess vascular status in patients following minor amputation typically includes a comprehensive noninvasive vascular evaluation. Options for PAD detection include cutaneous oximetry, pulse volume recording, photoplethysmography, segmental pressures, toe pressures and ultrasound in addition to angiographic studies, according to Dr. Blume, an Assistant Clinical Professor of Surgery in the Department of Surgery at the Yale University School of Medicine in New Haven, Ct.